NEED A QUOTE FOR EQUIPMENT?

Please take this opportunity to complete and return the following

Equipment Data Questionnaire (EDQ) to receive a no-obligation proposal for the equipment best suited to your specific application. To download a printable version of this form, please click here.

Upon receipt of your completed questionnaire, a specially trained Mole·Master representative will provide you with our recommendation for the equipment or speciality service that will solve your problem in the fastest, safest, and most economical way possible.

Note: Please fill out a questionnaire for the largest silo, bin, or vessel requiring cleanout or unclogging.

Don't have time to complete a questionnaire? No problem. Simply call 1.800.322.6653 (U.S.A. only) or 740.374.6726 and you will speak with a person ready to help solve your problem.

 
I. CONTACT INFORMATION   (Required fields are in red.)
Date: mm/dd/yy
Company Name:
Facility Name:
Mailing Address:
Country:
Mailing City/State/Zip: / /
Shipping Address:
Shipping City/State/Zip: / /
Contact Name:
Job Title:
(For international Phone, Mobile/Cell and Fax,
please include all country and dialing codes.)
Phone Main:
Phone Extension:
Mobile/Cell:
Fax:
**Email:
**If you would like to receive a digital version of your completed questionnaire, please enter your email address.
Send completed questionnaire to the following additional email addresses:
Email 1:  Email 2:  Email 3:
 
II. MATERIAL DETAILS
 
Name and Description  
of Material(s)  		  
Description of the Material (Check all that apply)
           
           
 
Planned Storage Capacity   Tons lbs. Bushels  
Amount of Built-Up Material
to be Removed		   Tons lbs. Bushels  
How High Does Non-Flowing
Material Extend Up the Walls? 		  Inches Feet Centimeters Meters
 
III. VESSEL DETAILS - EXTERIOR
A. Vessel Type
Type of Vessel – Please select from images as shown to the below right
 
B. Top View Dimensions
A:
B:
C:
D:
E:
 
F:
G:
H:
I:
J:
K:
L:
M:
N:

Is it divided?:

If divided, please describe
 
C. Side View Type
 
D. Side View Dimensions

A:
B:
C:
D:
E:
F:
G:
H:
I:
J:
K:
L:
M:
N:
O:
 
E. Roof Openings
Number of Openings (How Many Openings):
 

Shape of Openings:

 
Measurements:
A:   
B:   
C:   
D:   
E:   
 
Type of Roof:
   
If Peaked, Please Provide
Degree of Slope:		  
 
IV. POWER REQUIREMENTS
Available 3 Phase Power:
Volts
Hertz

Please fax or email a copy of the MSDS material along with any prints, drawings, or photographs available which can be used to clarify the dimensions or help us better understand the facility and problem description. Please also email any related documents to ContactUs@molemaster.com.

Thank you for completing this questionnaire.

Your information will be analyzed by one of our project managers who will prepare a proposal for your review.

If you require immediate assistance, please call our Rapid Response emergency number 1.800.322.6653 (available 24/7 in U.S.A. only).

Fax: 740.374.5908
Email:ContactUs@molemaster.com
 

Reminder: To receive a digital version of your completed questionnaire, please enter your email address in the Contact Section at the start of this form.

Note: Due to email filtering, there is a possibility that you may not receive a return email containing your completed questionnaire. Should this occur, please call us so that we may send a copy of your completed questionnaire.

Thank you.
IV. FINAL STEP